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A Review of Quality Measures for Assessing the Impact of Antimicrobial Stewardship Programs in Hospitals

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A Review of Quality Measures for Assessing the Impact of Antimicrobial Stewardship Programs in Hospitals. / Apkan, Mary; Ahmad, Raheelah; Shebl, Nada; Ashiru-Oredope, Diane.

In: Antibiotics, Vol. 5, No. 5, 13.01.2016, p. 1-16.

Research output: Contribution to journalLiterature reviewpeer-review

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Apkan, Mary ; Ahmad, Raheelah ; Shebl, Nada ; Ashiru-Oredope, Diane. / A Review of Quality Measures for Assessing the Impact of Antimicrobial Stewardship Programs in Hospitals. In: Antibiotics. 2016 ; Vol. 5, No. 5. pp. 1-16.

Bibtex

@article{4903bed24f38460abef3715514b134b3,
title = "A Review of Quality Measures for Assessing the Impact of Antimicrobial Stewardship Programs in Hospitals",
abstract = "The growing problem of antimicrobial resistance (AMR) has led to calls for antimicrobial stewardship programs (ASP) to control antibiotic use in healthcare settings. Key strategies include prospective audit with feedback and intervention, and formulary restriction and preauthorization. Education, guidelines, clinical pathways, de-escalation, and intravenous to oral conversion are also part of some programs. Impact and quality of ASP can be assessed using process or outcome measures. Outcome measures are categorized as microbiological, patient or financial outcomes. The objective of this review was to provide an overview of quality measures for assessing ASP and the reported impact of ASP in peer-reviewed studies, focusing particularly on patient outcomes. A literature search of papers published in English between 1990 and June 2015 was conducted in five databases using a combination of search terms. Primary studies of any design were included. A total of 63 studies were included in this review. Four studies defined quality metrics for evaluating ASP. Twenty-one studies assessed the impact of ASP on antimicrobial utilization and cost, 25 studies evaluated impact on resistance patterns and/or rate of Clostridium difficile infection (CDI). Thirteen studies assessed impact on patient outcomes including mortality, length of stay (LOS) and readmission rates. Six of these 13 studies reported non-significant difference in mortality between pre- and post-ASP intervention, and five reported reductions in mortality rate. On LOS, six studies reported shorter LOS post intervention; a significant reduction was reported in one of these studies. Of note, this latter study reported significantly (p < 0.001) higher unplanned readmissions related to infections post-ASP. Patient outcomes need to be a key component of ASP evaluation. The choice of metrics is influenced by data and resource availability. Controlling for confounders must be considered in the design of evaluation studies to adequately capture the impact of ASP and it is important for unintended consequences to be considered. This review provides a starting point toward compiling standard outcome metrics for assessing ASP. ",
keywords = "antimicrobial stewardship, antimicrobial resistance, quality indicators, outcome, patient, infectious diseases",
author = "Mary Apkan and Raheelah Ahmad and Nada Shebl and Diane Ashiru-Oredope",
note = "{\textcopyright} 2016 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons by Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/). Mary Richard Akpan, Raheelah Ahmad, Nada Atef Shebl and Diane Ashiru-Oredope, 'A Review of Quality Measures for Assessing the Impact of Antimicrobial Stewardship Programs in Hospitals', Antibiotics, 2016, Vol 5(5). The version of record is available online at doi: doi:10.3390/antibiotics5010005",
year = "2016",
month = jan,
day = "13",
doi = "10.3390/antibiotics5010005",
language = "English",
volume = "5",
pages = "1--16",
journal = "Antibiotics",
issn = "2079-6382",
publisher = "Multidisciplinary Digital Publishing Institute (MDPI)",
number = "5",

}

RIS

TY - JOUR

T1 - A Review of Quality Measures for Assessing the Impact of Antimicrobial Stewardship Programs in Hospitals

AU - Apkan, Mary

AU - Ahmad, Raheelah

AU - Shebl, Nada

AU - Ashiru-Oredope, Diane

N1 - © 2016 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons by Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/). Mary Richard Akpan, Raheelah Ahmad, Nada Atef Shebl and Diane Ashiru-Oredope, 'A Review of Quality Measures for Assessing the Impact of Antimicrobial Stewardship Programs in Hospitals', Antibiotics, 2016, Vol 5(5). The version of record is available online at doi: doi:10.3390/antibiotics5010005

PY - 2016/1/13

Y1 - 2016/1/13

N2 - The growing problem of antimicrobial resistance (AMR) has led to calls for antimicrobial stewardship programs (ASP) to control antibiotic use in healthcare settings. Key strategies include prospective audit with feedback and intervention, and formulary restriction and preauthorization. Education, guidelines, clinical pathways, de-escalation, and intravenous to oral conversion are also part of some programs. Impact and quality of ASP can be assessed using process or outcome measures. Outcome measures are categorized as microbiological, patient or financial outcomes. The objective of this review was to provide an overview of quality measures for assessing ASP and the reported impact of ASP in peer-reviewed studies, focusing particularly on patient outcomes. A literature search of papers published in English between 1990 and June 2015 was conducted in five databases using a combination of search terms. Primary studies of any design were included. A total of 63 studies were included in this review. Four studies defined quality metrics for evaluating ASP. Twenty-one studies assessed the impact of ASP on antimicrobial utilization and cost, 25 studies evaluated impact on resistance patterns and/or rate of Clostridium difficile infection (CDI). Thirteen studies assessed impact on patient outcomes including mortality, length of stay (LOS) and readmission rates. Six of these 13 studies reported non-significant difference in mortality between pre- and post-ASP intervention, and five reported reductions in mortality rate. On LOS, six studies reported shorter LOS post intervention; a significant reduction was reported in one of these studies. Of note, this latter study reported significantly (p < 0.001) higher unplanned readmissions related to infections post-ASP. Patient outcomes need to be a key component of ASP evaluation. The choice of metrics is influenced by data and resource availability. Controlling for confounders must be considered in the design of evaluation studies to adequately capture the impact of ASP and it is important for unintended consequences to be considered. This review provides a starting point toward compiling standard outcome metrics for assessing ASP.

AB - The growing problem of antimicrobial resistance (AMR) has led to calls for antimicrobial stewardship programs (ASP) to control antibiotic use in healthcare settings. Key strategies include prospective audit with feedback and intervention, and formulary restriction and preauthorization. Education, guidelines, clinical pathways, de-escalation, and intravenous to oral conversion are also part of some programs. Impact and quality of ASP can be assessed using process or outcome measures. Outcome measures are categorized as microbiological, patient or financial outcomes. The objective of this review was to provide an overview of quality measures for assessing ASP and the reported impact of ASP in peer-reviewed studies, focusing particularly on patient outcomes. A literature search of papers published in English between 1990 and June 2015 was conducted in five databases using a combination of search terms. Primary studies of any design were included. A total of 63 studies were included in this review. Four studies defined quality metrics for evaluating ASP. Twenty-one studies assessed the impact of ASP on antimicrobial utilization and cost, 25 studies evaluated impact on resistance patterns and/or rate of Clostridium difficile infection (CDI). Thirteen studies assessed impact on patient outcomes including mortality, length of stay (LOS) and readmission rates. Six of these 13 studies reported non-significant difference in mortality between pre- and post-ASP intervention, and five reported reductions in mortality rate. On LOS, six studies reported shorter LOS post intervention; a significant reduction was reported in one of these studies. Of note, this latter study reported significantly (p < 0.001) higher unplanned readmissions related to infections post-ASP. Patient outcomes need to be a key component of ASP evaluation. The choice of metrics is influenced by data and resource availability. Controlling for confounders must be considered in the design of evaluation studies to adequately capture the impact of ASP and it is important for unintended consequences to be considered. This review provides a starting point toward compiling standard outcome metrics for assessing ASP.

KW - antimicrobial stewardship

KW - antimicrobial resistance

KW - quality indicators

KW - outcome

KW - patient

KW - infectious diseases

U2 - 10.3390/antibiotics5010005

DO - 10.3390/antibiotics5010005

M3 - Literature review

VL - 5

SP - 1

EP - 16

JO - Antibiotics

JF - Antibiotics

SN - 2079-6382

IS - 5

ER -